Background: Numerous techniques have been used to rejuvenate the aging midface. The Endotine midface technique involves an endoscopic temporal approach, including midface dissection and malar suspension with fixation. The Endotine device (Microaire, Charlottesville, Virginia) eliminates the intraoral incision and use of sutures, enabling multipoint fixation and fast, simple adjustability for optimal control of midface elevation and volume. Objectives: The authors describe their preferred technique for the endoscopic midface lift and summarize their 13 years of experience. Methods: A retrospective chart review was conducted of 183 patients who underwent endoscopic midface surgery. Patients treated from 1998 to 2003 received direct needle fixation (n = 95). Those treated later underwent fixation with the Endotine device (n = 88). Results: Most (90%) of the patient population was female, and the average age at the time of surgery was 46 years (range, 39-54 years). Needle fixation was used in 95 patients and Endotine fixation in 88. The average follow-up period was 7 years. The authors have observed many improvements in outcomes since the introduction of the Endotine device into their practice. These include reduced swelling and bruising, more symmetric elevation of the malar fat pad, mild improvement of tear trough deformity, softening of the nasolabial folds, and, in some cases, decreased "jowling." The asymmetry often associated with direct needle fixation has decreased, and no skin dimpling has occurred. Through their experience, the authors' preferred technique has become the temporal-only approach with Endotine fixation. Conclusions: The Endotine midface suspension device enhances soft-tissue fixation, provides simple adjustability for optimal elevation and projection, and maintains mechanical fixation until biologic fixation becomes adequate. The 5 tines provide multiple points of contact for secure soft-tissue fixation. Elevation forces are evenly distributed over a wide area, which eliminates skin irregularities. Insertion and deployment are accomplished easily through temporal incision. Level of Evidence: 4.